Healthcare Provider Details

I. General information

NPI: 1053871962
Provider Name (Legal Business Name): HENRY NGUYEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST
DETROIT MI
48201-2119
US

IV. Provider business mailing address

7430 2ND AVE APT 340
DETROIT MI
48202-2738
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5870
  • Fax:
Mailing address:
  • Phone: 713-816-7553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.157711
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101028059
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: